HEMATOLOGIC

SYSTEM
 ASSESSMENT
NURSING • HEALTH HISTORY
PROCESS: • PHYSICAL EXAMINATION
ASSESSMENT • LABORATORY STUDIES &
DIAGNOSTIC TESTS
NURSING DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION
 STRUCTURE & BLOOD
FUNCTION OF THE CELLULAR ELEMENTS
HEMATOLOGIC PLASMA
SYSTEM RBC
WBC
PLATELETS
INTRINSIC PATHWAY
EXTRINSIC PATHWAY
COMMON PATHWAY
 • I. IRON DEFICIENCY ANEMIA
DISORDERS OF - Is a disorder in which
THE RED hemoglobin synthesis is
BLOOD CELLS : deficient and the body’s
capacity to transport oxygen
ANEMIA is impaired.
- Iron deficiency anemia
during pregnancy is
associated with low fetal birth
weight and preterm birth
 • I. IRON DEFICIENCY ANEMIA
DISORDERS OF -
THE RED
BLOOD CELLS :
ANEMIA
 • I. IRON DEFICIENCY ANEMIA
(COMPLICATION)
DISORDERS OF -

THE RED
BLOOD CELLS :
ANEMIA
DISORDERS II. SICKLE CELL DISEASE
OF THE RED
BLOOD CELLS
: ANEMIA
DISORDERS II. SICKLE CELL DISEASE
OF THE RED
BLOOD CELLS
: ANEMIA
 DISORDERS II. SICKLE CELL DISEASE
OF THE RED Pain related to joint swelling
BLOOD CELLS
: ANEMIA Knowledge Deficit related to
disease, treatment, and
prevention of crisis
II. SICKLE CELL DISEASE
II. SICKLE CELL DISEASE
 BRAINSTORMING
1. Why should a client with sickle cell anemia be concerned if he or
she marries a person with the sickle cell trait?

2. What defect is most commonly caused by anemia?

• a. Increased red blood cell count and blood viscosity
• b. Depressed hematopoietic system and hyperactivity
• c. Increased presence of abnormal hemoglobin
• d. Decreased capacity of blood to carry oxygen
 DISORDERS III. THALASSEMIA
OF THE RED - Thalassemia is a group
BLOOD CELLS of inherited blood disorders
characterized by a deficient
: ANEMIA synthesis of specific globulin
chains of the hemoglobin
molecule
 DISORDERS III. THALASSEMIA
OF THE RED EARLY SIGNS: insidious onset, anemia,
unexplained fever, poor feeding, poor
BLOOD CELLS weight gain, and a markedly enlarged
spleen
: ANEMIA LATER SIGNS: chronic hypoxia; damage
to liver, spleen, heart, pancreas, and
lymph glands from hemochromatosis
(damage causing excess iron); slight
jaundice or bronze skin color; thick
cranial bones with prominent cheeks
and a flat nose; growth retardation; and
delayed sexual development
 DISORDERS III. APLASTIC ANEMIA
OF THE RED - Aplastic anemia is
BLOOD CELLS characterized by pancytopenia
(anemia, granulocytopenia,
: ANEMIA and thrombocytopenia) and
bone marrow hypoplasia
DISORDERS III. APLASTIC ANEMIA
OF THE RED SIGNS & SYMPTOMS
BLOOD CELLS lack of red blood cells
(RBCs)
: ANEMIA
Lack of white blood cells
Lack of platelets
 DISORDERS III. APLASTIC ANEMIA
OF THE RED DIAGNOSTIC LAB TESTS
BLOOD CELLS *Peripheral blood smear
: ANEMIA Bone Marrow aspiration &
biopsy
DISORDERS III. APLASTIC ANEMIA
OF THE RED nursing management
BLOOD CELLS 1. Prevent infection
2. Assess for abnormal bleeding
: ANEMIA 3. Administer prescribed
medication and blood
products (Antilymphocyte
globulin (ALG) or
antithymocyte globulin (ATG)
4. Blood transfusion
 • HEMOPHILIA
DEFECTS ON
HEMOSTASIS - A group of hereditary
bleeding disorders
characterized by a
deficiency in a blood-
clotting disorder
DEFECTS ON • TWO COMMON FORMS
HEMOSTASIS Factor VIII deficiency
(HEMOPHILIA A) - It is caused by a
deficiency of antihemophilic
globulin C, which is the factor VIII
necessary for blood clotting
Factor IX deficiency
(HEMOPHILIA B) -
DEFECTS ON
HEMOSTASIS • CAUSES OF HEMOPHILIA
 • ETIOLOGY
DEFECTS ON
HEMOSTASIS
 • ASSESSMENT FINDINGS
1. MILD- hemophilia, characterized by a
DEFECTS ON factor level of 5% to 50%, children have
HEMOSTASIS prolonged bleeding only when they have
been injured.
2. MODERATE- hemophilia,
characterized by a factor level of 1% to
5%, prolonged bleeding occurs with
trauma or surgery, but there may be
episodes of spontaneous bleeding as
well
3.SEVERE HEMOPHILIA- characterized
by a factor level under 1%, prolonged
bleeding occurs spontaneously without
injury
 • NURSING MANAGEMENT
DEFECTS ON 1. Assess for acute or chronic
bleeding
HEMOSTASIS
2. Administer the missing clotting
factor
3. Administer Desmopressin (DDAVP)
to children with mild hemophilia A
4. Prevent or minimize bleeding
5. Provide Support
6. Provide Child and Family Teaching
 BRAINSTORMING

1. Common symptoms of hemophilia in children

include (a) ––––––––––,
(b) ––––––––––, (c) ––––––––––, (d) –––––––––
 • LEUKEMIA
NEOPLASTIC • Leukemia is the uncontrolled
reproduction of deformed white blood
DISORDERS cells.
• This rapid increase in lymphocytes
causes crowding, which in turn decreases
the production of red blood cells and
platelets
• The decrease in red blood cells, platelets,
and normal white blood cells causes the
child to become easily fatigued and
susceptible to infection and increased
bleeding
 • LEUKEMIA
NEOPLASTIC • - Bleeding from platelet suppression,
which includes widespread petechiae
DISORDERS (pinpoint hemorrhages beneath the
skin), purpura (hemorrhages into the
skin or mucous membranes) as a result
of a low thrombocyte count, hematuria,
epistaxis, and tarry stools; Easy bruising
is a constant problem
• General signs and symptoms, which
include weight loss, anorexia, and
vomiting, abdominal pain, bone pain
 • LEUKEMIA (Laboratory & Diagnostic
Findings)
NEOPLASTIC
DISORDERS
• Complete blood count
•Bone marrow aspiration
•Lumbar puncture
 • LEUKEMIA (Nursing Management)
NEOPLASTIC Prevent infection
DISORDERS Preventing bleeding & injury
Promoting energy conservation and
relieving anxiety
Promoting normal growth and
development
Promoting positive body image
Promoting family coping
 • LYMPHOMA
NEOPLASTIC
DISORDERS • The two most common lymphomas
seen in children are: HODGKIN’S
disease & Non-HODGKIN’S
lymphoma
 • LYMPHOMA - ETIOLOGY
NEOPLASTIC
DISORDERS
•The Epstein-Barr virus (EBV) is
believed to be a causative
agent
 • LYMPHOMA - PATHOPHYSIOLOGY
• - Cancerous transformation occurs from a
NEOPLASTIC particular site in thelymph node
DISORDERS
• - With continuing growth, the entire node
becomes replaced,with zones of necrosis
obscuring the normal nodular pattern

• - The mechanism of growth and spread of

Hodgkin’s disease remains unknown

• - Some have suggested that the disease

progresses byextension to adjacent structures
•
 • LYMPHOMA - CLINICAL
MANIFESTATION
NEOPLASTIC
DISORDERS
• Painless lymphadenopathy
• Enlarged lymphnodes (clavicles, cervical)
• Non-productive cough
• Engorgement of neck veins
• Edema of face, neck, & right arm
• Urinary retention, constipation,
compression of the cord
 • LYMPHOMA - STAGING

• Stage 1
NEOPLASTIC Involvement of a single lymph node region or a lymphoid
DISORDERS structure (e.g. spleen, thymus, Waldeyer’s ring)
• Stage II
Involvement of two or more lymph node regions on the same
side of the diaphragm (i.e. the mediastinum is a single site,
hilar lymph nodes are lateralized).
• Stage III
Involvement of lymph node regions or structures on both sides
of the diaphragm:
III1: with or without involvement of splenic, hilar,
celiac,or portal nodes
III2: with involvement of para-aortic, iliac, or
mesenteric nodes
• Stage IV
Involvement of extranodal site(s)
 • NON-HODGKIN’S DISEASE LYMPHOMA
- ETIOLOGY
NEOPLASTIC
DISORDERS
• NHL comprises a group of malignancies
with a common origin in the lymphoid
cells
• NHL is seven times more common than
HD
 • NON- HODGKIN’S DISEASE LYMPHOMA
- CLASSIFICATION
NEOPLASTIC
DISORDERS
•- Two major histopathologic patterns:
•o Nodular
•o Diffuse
 • NON- HODGKIN’S DISEASE LYMPHOMA
- PATHOPHYSIOLOGY
NEOPLASTIC
DISORDERS
• abnormal proliferation of neoplastic
lymphocytes occurs
• cells remain fixed at one phase of
development and continue to proliferate
• Both T and B lymphocytes mature in the
lymph nodes
• Clinical manifestations are due to
mechanical obstruction of the enlarged
lymph nodes
 • NON- HODGKIN’S DISEASE LYMPHOMA
NEOPLASTIC CLINICAL MANIFESTATION
DISORDERS
− localized or generalized
lymphadenopathy
• The cervical, axillary, inguinal, and
femoral clients are the most frequent
sites of lymph node enlargement
 • NON- HODGKIN’S DISEASE LYMPHOMA
NEOPLASTIC TREATMENT
DISORDERS
- Combination chemotherapy is used
to produce tumor shrinkage and remission
- Cyclophosphamide and doxorubicin
are active against lymphoma